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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www everettwa org <br />310J14. G6,,r R.P ,_Yer <br />+K (n/A 482ju3 <br />PROJECT ADDRESS <br />)( lai& Anna 0o m <br />310 Jf. Ub r ad <br />fverdliL <br />NA Alas-$42.5 <br />Owner 1jMall <br />Address <br />City <br />State/Zip Phone <br />Sam•j <br />Tenant <br />Mail Address <br />City <br />State/Zip Phone <br />Sri <br />Electrical Contractor <br />Mail Address <br />City <br />State/Zip Phone <br />State License Number (required) <br />City of Everett Business License Number (required) <br />$ I Suo <br />fia ltr om I Wilroarn ItU <br />Proposed Use cif Budding <br />It'd h <br />Contract Price of Work <br />300 S.f. <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (11 low voltage) <br />Description of Work to Be Done: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />Contact Person/Contact Number/Email <br />I hereby certify that I have read and examined :his application and know the some to be true and <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />whether specified herein or not. The granting of a permit does not presume to give authority to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construction. That I am authorized by the owner of this property to perform the <br />work for which application is male and I comply with the State Contractors Law 16.27 , end <br />296 200 WAC. <br />FEE <br />PERMTiJt - ------ <br />REVISED OMW14 <br />